Physician trust, early screening reduces disparities for prostate cancer

 
July 31, 2009
Men who have a regular, ongoing relationship with a health care provider are more likely to receive prostate cancer screening and less likely to be diagnosed with advanced prostate cancer, regardless of their race, according to a University of North Carolina study published in the current issue of the journal Cancer.

Dr. William Carpenter

Dr. William Carpenter

William R. Carpenter, PhD, research assistant professor of health policy and management in the UNC Gillings School of Global Public Health and a member of the the UNC Lineberger Comprehensive Cancer Center, authored the paper.

The study compared the experiences of black and white men over age 50 and newly diagnosed with prostate cancer in North Carolina and Louisiana. The goal was to find underlying reasons why African-American men have a higher incidence of prostate cancer and a higher rate of death from the disease than their white counterparts.

“We found that Caucasian (white) men tended to be seen regularly by the same physician, which appears to be associated with greater trust in their doctors and in physicians in general,” Carpenter said. “They were also more likely than their African-American counterparts to get regular prostate cancer screenings and to get all their medical care at a physician’s office.”

The study enrolled 1,031 black and white men, age 50 and older, within weeks of their prostate cancer diagnosis. A study nurse conducted a structured survey and acquired biological specimens in a home visit and obtained other medical information from each patient’s medical records.

In this study, the stage of prostate cancer at diagnosis was similar between races, but the mean Gleason scores, an indication of the aggressiveness of the disease, were higher for blacks than for whites. Blacks were less likely than whites to report participation in prostate cancer screening prior to diagnosis. Men without a prior history of screening were more likely to be diagnosed with advanced disease and/or more aggressive forms of prostate cancer. However, when men of either race had established relationships with a health care provider, the differences in prostate cancer stage at diagnosis went away.

“This evidence leads us to think that encouraging African-Americans to establish an ongoing relationship with a regular care provider may encourage more appropriate use of prostate cancer screening, and thus reduce racial disparities in prostate cancer diagnosis and treatment, which, by extension, may reduce disparities in prostate cancer deaths,” Carpenter said.

James Mohler, MD, chair of the department of urology at Roswell Park Cancer Institute in Buffalo, N.Y., and principal investigator of the study, said, “The goal of the study was to gain a deeper understanding of the role of racial disparities in prostate cancer outcomes. These findings suggest that differences in screening result from inconsistent or poorer quality interaction between an African-American man and the American health care system. If the interaction is poor, the care giver may not ‘get around to discussing or offering preventive health care, such as prostate cancer screening. Improving the interaction between all men, and especially African-American men, and their primary care givers should reduce prostate cancer deaths in all men and decrease the racial disparity in prostate deaths in African-American men.”

Mohler is a member of UNC Lineberger Comprehensive Cancer Center.

Carpenter added, “Factors in health care systems, including setting and continuity of care, may hinder the development of physician-patient relationships, and possibly preclude discussions beyond the immediate medical issue at hand, including discussions of preventive health and preferences in use of early detection. These factors and relationships can influence whether there are discussions beyond the immediate medical issue at hand, including discussions of preventive health and preferences in use of health care services such as prostate cancer screening.”

Other UNC authors include Paul Godley, MD, professor of medicine and adjunct professor of epidemiology in the schools of medicine and public health, Jeannette Bensen, PhD, research assistant professor of epidemiology, Merle Mishel, PhD, distinguished professor in the School of Nursing, and Timothy Finnegan, MD, in the School of Medicine.

Other authors include the study’s co-principal investigator, Elizabeth Fontham, PhD, from the Louisiana State University Health Science Center in New Orleans.

The research was supported by the U.S. Department of Defense and the National Cancer Institute.

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UNC Gillings School of Global Public Health contact: Ramona DuBose, director of communications, (919) 966-7467 or ramona_dubose@unc.edu.